HWN Suggests

‘Classic’ Findings of Effusion Not So Classic After All

Pericardial effusion often presents in not-so-obvious ways. We may not immediately think of effusion when we see patients with dyspnea, orthopnea, or chest pain. The “classic” findings of effusion are not so classic in reality. As with many things in EM, we set the tone for patient care, and our consultants or admitting services may anchor on our findings and diagnosis, causing delays when the diagnosis is not correct. It only takes a few seconds to check the heart for an effusion, but it can quickly change the course of a patient's care.

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  PoCUS in Pericardial Effusion

The normal pericardial sac contains up to 50 mL of plasma ultrafiltrate [1]. Any disease affecting the pericardium can contribute to the accumulation of fluid beyond 50mL, termed a pericardial effusion. The most commonly identified causes of pericardial effusions include malignancy and infection

 Differentiating pericardial effusion from pericardial tamponade on ultrasound

In order to know whether or not an intervention is necessary for the setting of pericardial effusion, ultrasound diagnosis of tamponade is paramount.

 POCUS

Echocardiography remains the diagnostic study of choice for the detection and evaluation of pericardial effusions.

Articles of Interest

Intern Ultrasound of the Month: Pericardial Effusion and Cardiac Tamponade in COVID-19 Pericarditis

Not all pericardial effusions cause tamponade. Remember - tamponade physiology depends on pressure, not the volume, of the pericardial effusion.

Pericardial Effusion and Cardiac Tamponade: Pearls and Pitfalls

Unless a hemodynamically significant effusion is present, patient’s presenting symptoms are usually nonspecific and insensitive.

Pericardial Effusion and Tamponade: Making the Diagnosis at Bedside With Point-of-Care Echocardiography

Pericardial effusions are usually an incidental finding on bedside echocardiogram—unless a patient shows clinical signs of tamponade physiology and obstructive shock.

Tamponade or No Tamponade: That is the question

Once a pericardial effusion has been identified, the critical issue becomes determining whether signs of cardiac tamponade are present.

Resources

Maimonides Emergency Medicine

Uh oh! A pericardial effusion! Next question, is this tamponade?

Emory University

The EKG shows the classic findings of a pericardial effusion - electrical alternans. You can see it well in the chest leads V5 & V6. The globus nature of the heart on the CXR should also make you think of pericardial effusion vs a dilated cardiomyopathy. The US is diagnostic - of interest, look at the PSLA and PSSA images closely